Re: [Felvtalk] Has anyone gone with radiation treatment for FeLV+ with cancer?

[Margo]

Marsha,                 I'm so sorry. I know how tough this kind of diagnosis is, having been there several times. I'm no Vet, but what you posted doesn't actually diagnose. It posits possibilities. I think where you go from here depend on your interest in treating as apposed to palliative care.                 If you would treat, then the biopsy is pretty important (IMO). It will tell you what you are dealing with, and whether there is an actual chemo protocol that might/will help. Some cancers are treatable than others. They might also be able to de-bulk the mass, and give Harley the ability to move his jaw without pain, at least for some time. My cat Pattern had what was finally diagnosed as SCC (Squamous Cell Carcinoma) in approximately the same area you identify, but the mass extended into her mouth, interfering with her ability to eat. At the time of the biopsy, the Vet removed all she could get and used silver nitrate to staunch the considerable bleeding (I was present). SCC is pretty much non-responsive to chemo, so we decided to hospice. She was with us for another 10 _good_ months. Sounds as if Harley is looking at something quite different, possibly treatable. Before you decide, you might want to run the results past some more knowledgeable people. If you aren't already a member, consider joining  https://groups.yahoo.com/neo/groups/feline_lymphoma/info and https://groups.yahoo.com/neo/groups/feline-cancer/info . There are members and Vets there (the lymphoma list has an amazing Vet participating pretty much daily) who can help decipher the lab results. Hoping for the best, Margo -----Original Message----- From: Marsha Sent: Mar 15, 2015 4:36 PM To: felvtalk@felineleukemia.org Subject: [Felvtalk] Has anyone gone with radiation treatment for FeLV+ with cancer? Harley had a CT scan on Monday, and needle biopsy Friday.  Saturday (yesterday) the report came back that he has cancer.  It is in the area of his right middle ear and TMJ.  By the CT images, it does not appear to be something operable - it does not have distinct borders and there is no room to get margins.  I have many things to discuss with vets tomorrow:  comfort care for the time being for sure; how effective is radiation treatment vs. benefit to Harley; are there any chemo protocols for this that can help?  Also they push for a full biopsy requiring surgery because the diagnosis will be more "definitive" and they could stage the cancer then.  But I question the cost (both money and physical discomfort to Harley) vs. benefit to him.  How will the full biopsy change potential treatment?  It will cost money, has risk due to anesthesia, location of mass, and possible infection, and will cause him some pain afterwards.  Is it worth it for the extra bit of detail?  Below is the report if you're interested, and able to read the technical stuff.  One note on the final comment that radiographs are recommended to rule out bone involvement:  the CT scan showed already showed bone lysis (erosion), but the pathologist did not have access to the info from the CT scan. In the meantime, Harley has gotten meloxicam or buprenorphine when he doesn't want to eat.  The anti-inflammatory effects of meloxicam give him relief for 4 days or so, allowing him to eat comfortably.  I just worry about potential kidney toxicity with that drug, so they have to be really careful about dosing, and the risk goes up long-term.  I wouldn't ordinarily say yes to that drug, but it helps him.  And if he's not going to make it long-term, the kidney concern takes back seat to his comfort.  The buprenorphine doesn't help nearly as much, but may make him feel good.  He has been eating all his food for the last 5 days, and plays and grooms himself.  A little more subdued than usual, but he has a big burst of energy after his breakfast or dinner. Marsha CLINICAL INFORMATION: Mass adjacent to/involving the right tympanic bulla; painful to open mouth; bulge palpated through skin medial to the right caudal mandible suspected to be the mass; blind aspirate; concern for carcinoma; patient is FeLV positive; regional node (and all peripheral nodes) palpate normal SOURCE: Mass adjacent to roof of mouth right side: 12 slides DESCRIPTION/MICROSCOPIC FINDINGS/COMMENTS: Microscopic Description: The smears are low to moderately cellular on a clear background with moderate blood contamination, many scattered platelet clumps and a low to moderate number of ruptured cells. Few small, loosely cohesive clusters of polygonal to cuboidal epithelial cells are observed. This population exhibits mild to moderate anisocytosis and anisokaryosis. The cells have a small amount of variably staining purple cytoplasm and a round central nucleus. The nuclei have finely stippled to reticular chromatin and often 1-2, small prominent nucleoli. There are also rare mesenchymal cells noted displaying oval nuclei, one to three small nucleoli and moderate amounts of basophilic cytoplasm. This population exhibits mild to moderate anisocytosis and anisokaryosis and occasionally surrounds a small to moderate amount of pink extracellular matrix. No infectious agents or cytologic evidence of inflammation are observed. Microscopic Findings: EPITHELIAL NEOPLASIA; MILD TO MODERATELY ATYPICAL MESENCHYMAL CELLS Comment: The observed epithelial population exhibits only mild atypia but based on the number seen and the provided history raise concern for a well-differentiated, malignant neoplasm. Cell morphology of this population is most consistent with a basal cell, ceruminous gland or apocrine gland population. Significance of the rare mesenchymal cells is uncertain (they could be a fibrous component associated with the mass/granulation tissue, connective tissue, possibly rare cells associated with a well-differentiated mesenchymal tumor). Tissue biopsy with histopathology is recommended for a specific diagnosis. Radiographs of the area are also recommended to completely rule out underlying bone involvement.

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